02 PHYSICS

55. General aspects

of pressure
‘Dum dum dum didi da dum insanity laughs under pressure we’re cracking’
— David Bowie

Questions on pressure can start innocently enough but can lead to almost any aspect of anaesthesia. One college
question starts by comparing the pressure generated in 2 and 20 mL syringes and ends up with altitude effects via
calibration of pressure transducers.

Define pressure. Pressure is the force applied per unit area. Its SI unit is the pascal (N/m2).
What is force? Force is a vector quantity that can cause an object with mass to accelerate.
Newton’s second law defined force as the mass of an object multiplied by its
acceleration. Its SI unit is the newton.
One newton will accelerate a 1 kg mass at 1 m/s2 in a vacuum. Gravity gives
any object an acceleration of 9.81 m/s2 making one newton equivalent to a
102 g weight. This is a small pressure when applied to a squared metre area,
so pressure is normally expressed in kilopascals (kPa).
What other units of pressure 1 bar is equivalent to:
are there? > 1 atmosphere
> 14.5 lb/in2 (psi)
> 30 inches of Hg
> 101 kPa
> 760 mmHg (torr)
> 1020 cm H2O
Are you more likely to dislodge a A 2 mL syringe, as pressure is force over area. The 2 mL syringe has a
blockage in a cannula when using smaller cross-sectional area so the force applied by the thumb is spread
a 2 or 20 mL syringe? over a smaller area generating a higher pressure. For this reason care must
be taken when injecting fluids with a small syringe as the high pressure
generated could cause tissue damage.
What is the difference between Dalton’s law states that in a gas mixture the pressure exerted by each
partial and total pressures? individual gas is equal to the pressure that gas would exert if it occupied the
container alone. This is the partial pressure (the term ‘tension’ refers to the
pressure exerted by a gas dissolved in liquid). Total pressure is the sum of all
the partial pressures in the mixture.
Is atmospheric pressure constant? No. Atmospheric pressure is created by the force of gravity acting on the
molecules that make up the atmosphere and therefore atmospheric pressure
will depend on the height of the atmosphere and its density. This means
that atmospheric pressure will fall with altitude and rising temperature. As a
consequence, the partial pressure of the gases that make up the air will also
fall, leading to low partial pressures of oxygen at altitude.

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What is gauge pressure?
What is absolute pressure?
Is blood pressure an absolute
or gauge pressure?
How do manometers work?
What are barometers?
How do aneroid gauges work?
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GENERAL ASPECTS OF PRESSURE
Gauge pressure refers to pressure measurements above or below
atmospheric pressure. An empty cylinder pressure will have a gauge
pressure of zero.
Absolute pressure refers to pressure measurements incorporating
atmospheric pressure – it is gauge pressure plus atmospheric pressure.
An empty cylinder will have an absolute pressure of 1 bar.
Blood pressure is a gauge pressure.
> A manometer consists of a fluid-filled column, which is open to the
atmosphere and therefore reads gauge pressure.
> Gravity acts on the fluid to produce a pressure, which is dependent on
the density of the fluid and the height of the fluid but independent of
the cross-sectional area of the column (pressure = height × density ×
gravitational force).
> They are used to measure low pressures.
> Inaccuracies can be caused by surface tension. This leads to an
over-reading in water manometers and an under-reading in mercury
manometers (in practice this has no clinical significance as a 6-mm-wide
column of water will only over-read by 0.04 kPa).
> They can be made more sensitive by using fluids with a low density
(e.g. a pressure of 1 kPa will support a column of mercury 7.5 mm high
or a column of water 10.2 cm high).
> Barometers are closed to the atmosphere and therefore measure
absolute pressure.
> A mercury barometer has a Torricellian vacuum above it, which contains
mercury vapour at its saturated vapour pressure (SVP).
> Barometers like the Fortin’s barometer and Goethe’s device can be
used to measure sub-atmospheric pressures. Here, the height of the
measuring column falls rather than rising and this principle was used to
predict bad weather; low atmospheric pressures would cause a fall in the
height of the fluid in a ‘thunder tube’, predicting an oncoming storm.
> Aneroid gauges (from the Greek meaning ‘no water’) such as the
Bourdon gauge are used to measure high pressures where manometers
would be impractical (e.g. to measure the pressure of a 137 bar oxygen
cylinder you would need a mercury column 104 m high or a water column
1394 m high!).
> A Bourdon gauge consists of a coiled metal tube linked to a cog and
a pointer. The cross-sectional area of the tube is elliptical and when
exposed to increases in pressure it changes to a circular cross-sectional
shape, which causes the tube to uncoil, moving the pointer across a
scale.
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